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  • Most of you can probably relate to what I'm feeling right now.

  • My heart is racing in my chest.

  • My palms are a little bit clammy.

  • I'm sweating.

  • And my breath is a little bit shallow.

  • Now, these familiar sensations are obviously the result

  • of standing up in front of a thousand of you

  • and giving a talk that might be streamed online

  • to perhaps a million more.

  • But the physical sensations I'm experiencing right now

  • are actually the result of a much more basic mind-body mechanism.

  • My nervous system is sending a flood of hormones

  • like cortisol and adrenaline into my bloodstream.

  • It's a very old and very necessary response that sends blood and oxygen

  • to the organs and muscles that I might need

  • to respond quickly to a potential threat.

  • But there's a problem with this response,

  • and that is, it can get over-activated.

  • If I face these kinds of stressors on a daily basis,

  • particularly over an extended period of time,

  • my system can get overloaded.

  • So basically, if this response happens infrequently: super-necessary

  • for my well-being and survival.

  • But if it happens too much,

  • it can actually make me sick.

  • There's a growing body of research examining the relationship

  • between chronic stress and illness.

  • Things like heart disease and even cancer

  • are being shown to have a relationship to stress.

  • And that's because, over time, too much activation from stress

  • can interfere with my body's processes that keep me healthy.

  • Now, let's imagine for a moment that I was pregnant.

  • What might this kind of stress,

  • particularly over the length of my pregnancy,

  • what kind of impact might that have

  • on the health of my developing fetus?

  • You probably won't be surprised when I tell you

  • that this kind of stress during pregnancy is not good.

  • It can even cause the body to initiate labor too early,

  • because in a basic sense, the stress communicates

  • that the womb is no longer a safe place for the child.

  • Stress during pregnancy is linked with things like high blood pressure

  • and low infant birth weight,

  • and it can begin a cascade of health challenges

  • that make birth much more dangerous

  • for both parent and child.

  • Now of course stress, particularly in our modern lifestyle,

  • is a somewhat universal experience, right?

  • Maybe you've never stood up to give a TED Talk,

  • but you've faced a big presentation at work,

  • a sudden job loss,

  • a big test,

  • a heated conflict with a family member or friend.

  • But it turns out that the kind of stress we experience

  • and whether we're able to stay in a relaxed state long enough

  • to keep our bodies working properly

  • depends a lot on who we are.

  • There's also a growing body of research

  • showing that people who experience more discrimination

  • are more likely to have poor health.

  • Even the threat of discrimination,

  • like worrying you might be stopped by police while driving your car,

  • can have a negative impact on your health.

  • Harvard Professor Dr. David Williams,

  • the person who pioneered the tools that have proven these linkages,

  • says that the more marginalized groups in our society

  • experience more discrimination and more impacts on their health.

  • I've been interested in these issues for over a decade.

  • I became interested in maternal health

  • when a failed premed trajectory instead sent me down a path

  • looking for other ways to help pregnant people.

  • I became a doula,

  • a lay person trained to provide support

  • to people during pregnancy and childbirth.

  • And because I'm Latina and a Spanish speaker,

  • in my first volunteer doula gig at a public hospital in North Carolina,

  • I saw clearly how race and class impacted the experiences

  • of the women that I supported.

  • If we take a look at the statistics about the rates of illness

  • during pregnancy and childbirth,

  • we see clearly the pattern outlined by Dr. Williams.

  • African-American women in particular

  • have an entirely different experience than white women

  • when it comes to whether their babies are born healthy.

  • In certain parts of the country, particularly the Deep South,

  • the rates of mother and infant death for black women

  • actually approximate those rates in Sub-Saharan African.

  • In those same communities,

  • the rates for white women are near zero.

  • Even nationally, black women are four times more likely

  • to die during pregnancy and childbirth

  • than white women.

  • Four times more likely to die.

  • They're also twice as likely for their infants to die

  • before the first year of life

  • than white infants,

  • and two to three times more likely

  • to give birth too early or too skinny --

  • a sign of insufficient development.

  • Native women are also more likely to have higher rates of these problems

  • than white women,

  • as are some groups of Latinas.

  • For the last decade as a doula turned journalist and blogger,

  • I've been trying to raise the alarm

  • about just how different the experiences of women of color,

  • but particularly black women,

  • are when it comes to pregnancy and birth in the US.

  • But when I tell people about these appalling statistics,

  • I'm usually met with an assumption that it's about either poverty

  • or lack of access to care.

  • But it turns out, neither of these things tell the whole story.

  • Even middle-class black women still have much worse outcomes

  • than their middle-class white counterparts.

  • The gap actually widens among this group.

  • And while access to care is definitely still a problem,

  • even women of color who receive the recommended prenatal care

  • still suffer from these high rates.

  • And so we come back to the path

  • from discrimination to stress to poor health,

  • and it begins to paint a picture that many people of color know to be true:

  • racism is actually making us sick.

  • Still sound like a stretch?

  • Consider this: immigrants, particularly black and Latina immigrants,

  • actually have better health when they first arrive in the United States.

  • But the longer they stay in this country, the worse their health becomes.

  • People like me, born in the United States to Cuban immigrant parents,

  • are actually more likely to have worse health than my grandparents did.

  • It's what researchers call "the immigrant paradox,"

  • and it further illustrates

  • that there's something in the US environment

  • that is making us sick.

  • But here's the thing:

  • this problem, that racism is making people of color,

  • but especially black women and babies, sick, is vast.

  • I could spend all of my time with you talking about it,

  • but I won't, because I want to make sure to tell you about one solution.

  • And the good news is, it's a solution that isn't particularly expensive,

  • and doesn't require any fancy drug treatments

  • or new technologies.

  • The solution is called, "The JJ Way."

  • Meet Jennie Joseph.

  • She's a midwife in the Orlando, Florida area

  • who has been serving pregnant women for over a decade.

  • In what she calls her easy-access clinics,

  • Jennie and her team provide prenatal care to over 600 women per year.

  • Her clients, most of whom are black, Haitian and Latina,

  • deliver at the local hospital.

  • But by providing accessible and respectful prenatal care,

  • Jennie has achieved something remarkable:

  • almost all of her clients give birth to healthy, full-term babies.

  • Her method is deceptively simple.

  • Jennie says that all of her appointments start at the front desk.

  • Every member of her team, and every moment a women is at her clinic,

  • is as supportive as possible.

  • No one is turned away due to lack of funds.

  • The JJ Way is to make the finances work no matter what the hurdles.

  • No one is chastised for showing up late to their appointments.

  • No one is talked down to or belittled.

  • Jennie's waiting room feels more like your aunt's living room than a clinic.

  • She calls this space "a classroom in disguise."

  • With the plush chairs arranged in a circle,

  • women wait for their appointments in one-on-one chats

  • with a staff educator,

  • or in group prenatal classes.

  • When you finally are called back to your appointment,

  • you are greeted by Alexis or Trina,

  • two of Jennie's medical assistants.

  • Both are young, African-American and moms themselves.

  • Their approach is casual and friendly.

  • During one visit I observed,

  • Trina chatted with a young soon-to-be mom

  • while she took her blood pressure.

  • This Latina mom was having trouble keeping food down due to nausea.

  • As Trina deflated the blood pressure cuff,

  • she said, "We'll see about changing your prescription, OK?

  • We can't have you not eating."

  • That "we" is actually a really crucial aspect of Jennie's model.

  • She sees her staff as part of a team that, alongside the woman and her family,

  • has one goal:

  • get mom to term with a healthy baby.

  • Jennie says that Trina and Alexis are actually the center of her care model,

  • and that her role as a provider is just to support their work.

  • Trina spends a lot of her day on her cell phone,

  • texting with clients about all sorts of things.

  • One woman texted to ask if a medication she was prescribed at the hospital

  • was OK to take while pregnant.

  • The answer was no.

  • Another woman texted with pictures of an infant born under Jennie's care.

  • Lastly, when you finally are called back to see the provider,

  • you've already taken your own weight in the waiting room,

  • and done your own pee test in the bathroom.

  • This is a big departure from the traditional medical model,

  • because it places responsibility and information

  • back in the woman's hands.

  • So rather than a medical setting where you might be chastised

  • for not keeping up with provider recommendations --

  • the kind of settings often available to low-income women --

  • Jennie's model is to be as supportive as possible.

  • And that support provides a crucial buffer

  • to the stress of racism and discrimination facing these women every day.

  • But here's the best thing about Jennie's model:

  • it's been incredibly successful.

  • Remember those statistics I told you,

  • that black women are more likely to give birth too early,

  • to give birth to low birth weight babies,

  • to even die due to complications of pregnancy and childbirth?

  • Well, The JJ Way has almost entirely eliminated those problems,

  • starting with what Jennie calls "skinny babies."

  • She's been able to get almost all her clients to term

  • with healthy, chunky babies like this one.

  • Audience: Aw!

  • Miriam Zoilarez: This is a baby girl

  • born to a client of Jennie's this past June.

  • A similar demographic of women in Jennie's area

  • who gave birth at the same hospital her clients did

  • were three times more likely to give birth

  • to a baby below a healthy weight.

  • Jennie is making headway into what has been seen for decades

  • as an almost intractable problem.

  • Some of you might be thinking,

  • all this one-on-one attention that The JJ Way requires

  • must be too expensive to scale.

  • Well, you'd be wrong.

  • The visit with the provider is not the center of Jennie's model,

  • and for good reason.

  • Those visits are expensive, and in order to maintain her model,

  • she's got to see a lot of clients to cover costs.

  • But Jennie doesn't have to spend a ton of time with each woman,

  • if all of the members of her team can provide the support, information

  • and care that her clients need.

  • The beauty of Jennie's model is that she actually believes

  • it can be implemented in pretty much any health care setting.

  • It's a revolution in care just waiting to happen.

  • These problems I've been sharing with you are big.

  • They come from long histories of racism, classism,

  • a society based on race and class stratification.

  • They involve elaborate physiological mechanisms

  • meant to protect us,

  • that, when overstimulated, actually make us sick.

  • But if there's one thing I've learned from my work as a doula,

  • it's that a little bit of unconditional support can go a really long way.

  • History has shown that people are incredibly resilient,

  • and while we can't eradicate racism

  • or the stress that results from it overnight,

  • we might just be able to create environments that provide a buffer

  • to what people of color experience on a daily basis.

  • And during pregnancy, that buffer can be an incredible tool

  • towards shifting the impact of racism

  • for generations to come.

  • Thank you.

  • (Applause)

Most of you can probably relate to what I'm feeling right now.